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As the region’s leading health system, our organization recognized the need to attract, retain and engage registered nurses as well as plan for the impending national nursing workforce shortage. A well designed, collaborative employer-employee professional nursing career framework functions as a guiding strategy for a registered nurse’s development and as a tool that sets the stage for when a registered nurse’s preparation for advancement coincides with the organization’s opportunities and needs (Philippou, 2015). Quality Safety Education for Nurses (QSEN) competencies address the challenge of engaging and employing nurses with the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work (Cronenwett, et. al, 2007; Cronenwett, et. al, 2009). The QSEN competencies are the core competencies that clinical nurses in the workforce must possess to meet the needs of our 21st century healthcare system.
Project Purpose: The purpose is to describe how systems thinking leadership and interprofessional collaborative partnerships can drive organizational change by intellectually engaging nurses through a professional career framework. This presentation demonstrates the journey one accountable care organization took to meet the changing needs of the community by addressing current and future workforce shortages by building a sustainable nursing career development framework supported by QSEN competencies.
Project Scope: The scope of this project encompasses more than 5500 professional clinical nurses across the entire spectrum of care settings within one accountable care organization. It includes clinical nurses and advanced practice nurses practicing in 17 acute care facilities, home care, over 200 physician groups/ambulatory clinics, five senior care facilities and comprehensive palliative care and hospice services.
Project Methods: Systems thinking served as the paradigm for this organization by which to create a new Framework for managing nursing careers. In partnership with human resources, a professional nursing career framework was designed to provide nursing career progression options within the system. Companies become innovative and desirable when the interdependencies and interrelatedness of organizational parts are examined as a whole (Senge, 1990; Shaked & Schechter, 2013). In designing the nursing career development framework, the interprofessional team desired to achieve an outcome of becoming a true learning organization, where nurses could grow professional roots with career mobility within the same organization. Both self-mastery and team learning advance because knowledge, skills, and attitudes progress in a symbiotic relationship. Often, individual learning and growth begins with a focus on student or novice performance, which establishes an essential building block of personal competence (Currey, Eustace, Oldland, Glanville, & Story, 2015). As an individual moves through the continuum from a novice to an advanced beginner to a competent performer and eventually, an expert, their professional practice changes iteratively (Benner, 1984). Adoption of a lifelong learning approach as a way to facilitate professional development is essential for systems leaders (Shaked & Schechter, 2013). The addition of team learning advances self-mastery exponentially (Currey et al., 2015). Thus, this organization’s focus was to design a nursing career development framework that supported individual learning and growth as well as team performance benefit. Kotter’s model of change management played a significant role in the project plan and work design. It continues to serve as a guide for implementation and evaluation of the career development framework. This large healthcare organization embedded the QSEN competencies into a nursing career development framework to ensure that career management was grounded in evidence and core professional competencies.
The nursing process was the guiding methodology for this project. In the assessment phase, an interprofessional team was formed that included Chief Nurse Officers (CNOs), directors of nursing representing a variety of care settings, nurse scientist, clinical nurses, human resources, and compensation associates. The team immediately determined standardization and consistency in nursing job descriptions was a high priority to reduce variation in professional practice. Throughout the planning phase, integration of the QSEN competencies was foundational to the design of the career framework elements and the development of standardized job descriptions. Robust project planning drove achievement of key milestones to advance the framework into final format. Key stakeholder groups were involved in planning and provision of input and feedback. Implementation is supported by Kotter’s model of change. The sense of urgency around current and forecasted workforce shortages and nursing role description variation drove the formation of the interprofessional guiding coalition to address these needs. A vision and strategy was developed in partnership with human resources for global application across all employee groups within the company. Communication planning occurs in an ongoing fashion through a variety of methods. Empowering nursing employees to participate in the career framework design and routinely for program input and feedback has promoted the socialization of this project. Short term wins include a shift from the existing compensation models to that of a career advancement paradigm, as well as increasing system-wide project interest and infrastructure changes to support new workflows. The guiding coalition continues to work on consolidation of wins and introduction of more change while this new framework becomes anchored in the culture. Evaluation metrics were determined at the beginning of the project. The core interprofessional team continues to monitor and report results to key organizational stakeholders.
Project Outcomes: A nursing career development framework with embedded QSEN competencies was developed for the organization. The nursing career framework includes five career bands and job levels that increase in complexity and responsibility while defining career progression both horizontally and vertically. 4500 job descriptions were consolidated to 1600 and standardized to include QSEN core competencies. Operational tools developed include project tools (charter, plan, Gantt chart); expansive nursing career development map; nursing job and roles placement in career map; tools to document career advancement and approval process; and multiple communication tools, including infographics to inform key constituents of project progress. The nursing career framework provides clarity around jobs and job hierarchy; provides transparency for career advancement; facilitates talent mobility; creates consistent alignment for reward and talent management decisions and supports pay for performance culture.
Project Practice Implications: The nursing career framework development is significant because it advances nursing professional practice in the context of quality and safety. The nursing career framework standardizes nursing job descriptions across care settings, role requirements and functions, competencies and responsibilities within the QSEN competencies. Implementation of a nursing career framework facilitates talent mobility across a healthcare system with leaders as coaches acting to guide careers. The framework benefits talent recruiters and supports development of a compensation model to reward advancement. Mitigation of current and future workforce crisis, along with advancing the future of nursing, innovating the healthcare delivery model, and transition to a care coordination framework are high priority areas for nurse leaders. The interdependencies between nursing and key professionals such as human resources, recruitment, talent management teams, and academic partners describe how managing nurses’ careers must be done with systems thinking and in true collaborative partnership.